Enroll a Child Child's First Name: Child's Last Name: Parent/Guardian's First Name: Parent/Guardian's Last Name: Parent/Guardian's Relationship to Child:--None--Mother Father Sister Guardian Brother Guardian Step-Mother Step-Father Grandmother Grandfather Aunt Uncle Other Relative Foster Parent God Parent Other Non-relative Street: City: State: Zip Code: County:--None--Fulton Gwinnett DeKalb Cobb Cherokee Paulding Douglas Fayette Clayton Henry Butts Rockdale Barrow Other Spanish Speaking?:--None--Yes No Limited Parent/Guardian's Mobile Phone: Parent/Guardian's Email: Child's Date of Birth: Child's Gender:--None--Male Female Child's Ethnicity:American Indian or Alaskan Native Asian Black or African American Hispanic or Latino Native Hawaiian or Pacific Islander White Other Multi-race (check all that apply) Does your child have a parent or loved one who has ever been incarcerated, even for a day?:--None--Yes No How did you hear about us?:--None--BBBS Board/ Staff College Partner Community Partner Corporate Partner Faith Organization Foster Home Fraternity/ Sorority Legal System Neighbor/ Friend Other Advertising Other Big Other Little/Parent Previous Involvement/ Self Relative School Social Media Special Event Therapist/ Counselor Website Does your child see a counselor or therapist?:--None--Yes No
